The Minnesota Heart Survey (MHS) is among the few population- based longitudinal studies to monitor and explain trends in coronary heart disease (CHD) mortality and morbidity; the leading cause of death and disability in the United States. It encompasses a large and well defined community, the Minneapolis/St. Paul (Twin Cities) metropolitan area of Minnesota, comprising a population of 2.3 million (1990 census). For almost two decades, MHS has made contributions to: 1) understanding the components of the decline of coronary heart disease mortality including incidence rate, hospitalized attack rate, case fatality, and population levels of CHD risk factors; and 2) the methodology of disease surveillance in a time when classification and diagnostic technologies are constantly changing. In the last grant period, MHS morbidity and mortality surveillance has found: 1) a continued decline in age-adjusted CHD death rates through 1995 for both men and women; 2) continued improved survival of hospitalized AMI patients in the first half of the 1990's; 3) more modest declines of out-of-hospital sudden cardiac death during the 1990's resulting in an increasing preponderance of out-of-hospital compared to in-hospital CHD mortality; 4) declining rates of hospitalized AMI including incident and recurrent events for both men and women in the 1990's; 5) a modest change in event severity for AMI; 6) dramatic improvements in two year case fatality after validated hospitalized AMI; and 7) significant increases in the use of appropriate medications, diagnostic procedures and therapeutic procedures during AMI in the setting of dramatic declines in length of hospital stay. In this application, we propose to continue efficient MHS data collection in the following domains: 1) continue surveillance of coronary heart disease mortality through the year 2002; 2) monitoring trends in AMI occurrence and survival by surveillance of hospitalized AMI in the year 2000; 3) evaluation of the effect on AMI diagnosis of the widespread use of new, highly sensitive and specific biomarkers (troponins); and 4) evaluation of out-of- hospital sudden cardiac death (SCD) through an autopsy in a population sample of victims utilizing modern anatomical, histological, toxicologic and interview-based data to better characterize this fatal condition.